APEX Brain Centers

A Commentary on Concussion, Mild Traumatic Brain Injury (mTBI), and Chronic Traumatic Encephalopathy (CTE)

As the buzz surrounding the release of the projected Christmas blockbuster movie Concussion grows; the evidence continues to mount in support of the seemingly insurmountable challenges posed by this ‘silent epidemic’.

Continued reporting from one of America’s most trusted public television investigative news sources, PBS’s FRONTLINE, demonstrates the urgency of the matter at hand; and the extremes to which it can lead… Dementia and, in severe cases, death!

The most recent FRONTLINE update from September 18, 2015, based on research from the Department of Veterans Affairs and Boston University, can be viewed in their article entitled New: 87 Deceased NFL Players Test Positive for Brain Disease. The most shocking part of this reporting is that the disease, chronic traumatic encephalopathy (CTE), was found in 87 of 91 players’ brain testing. Let that soak in for a moment… That is 96% of the brains testing in this particular ongoing study show signs of a potentially avoidable killer disease. We will come back to this in a moment.

Some definitions, facts, and stats to ponder:

  • A concussion is a traumatic brain injury that alters the way your brain functions
  • Most sports-related concussions (almost 90%) occur with NO loss of consciousness (LOC)
  • A median of 2. 7 million TBIs occur in the US each year (go unreported), cost nearly $50 billion annually
  • Symptoms of concussion include: headache, dizziness, balance and speech problems, nausea, light and noise sensitivities, memory and concentration difficulties, behavioral and emotional struggles, and anything out of the ordinary observed that was not an issue prior to the event/s
  • Risk factors for concussion include: prior concussion, vertigo/dizziness, alcohol/drugs, high-risk behaviors and sports (e.g. football, hockey, soccer, etc.), military conflict, abusive relationships, driving, and high-risk occupations (e.g. construction, utility work, etc.)
  • Mild traumatic brain injury (mTBI) is another word for concussion; even though, in my opinion, there is no such thing as a ‘mild’ brain injury
  • Chronic traumatic encephalopathy (CTE) is a progressive degenerative disorderring of the brain found in those with a history of repetitive brain trauma
  • Symptoms of CTE include: memory and executive function decline, depression, irritability, impulsivity, aggressiveness, suicidal behavior, eventual progression to dementia

(All facts and figures presented are courtesy of the Centers for Disease Control and Prevention and The Mayo Clinic)

***Did you know??? Those with ADHD are significantly more likely to experience worse outcomes with a concussion than their non-ADHD peers. This is of extremely important note as many children are placing in sports to control problematic behavioral and academic challenges. Read the abstract from a paper on this topic presented in the Journal of Neurosurgery: Pediatrics***

Back to the FRONTLINE reporting of 96% of the NFL players’ brains containing direct indications of CTE. What is being revealing in this ongoing study is one of, if not the most, statistically significant findings of our times. Consider for a moment if you will… If there were an outbreak of any communicable disease in a family, school, small town, cruise ship, controlled group s; it would take, in most cases, less than 1% of the population being affecting to mobilize critical resources to control and eliminate such an outbreak. Why is nothing being done to preventing and treat this largely controllable epidemic that has been unfolding before our very eyes for some time now?

While there is an extraordinary amount of activity and funding being directing towards this catastrophe, we are still largely no further along in the detection, advocacy, and treatment for this ‘silent epidemic’. As a clinician who has been in the trenches working with concussion and TBI for over 15 years, the stark reality is that the vast majority of patients that have walked through the doors of our Center have been given the same advice: “Wait and see”. That is, to go without treatment in hopes of symptoms subsiding; which, in rough estimates from various sources, will not happen in approximately 25% of cases! In other words, at least one in 4 will continue with any or all of the debilitating symptoms listed above.

Why “wait and see”? The primary tests utilized after one has sustained a hit to the head and suspected brain injury in nature. What this means is if you have nothing that shows up on a CT scan or MRI, structurally ‘OK’.

There are a great number of ‘biomarkers’ of brain function that can be measuring with great precision – that is. What follows are some examples of these biomarkers that can be measuring and improved in cases of concussion and TBI:

  • Balance/Gait
  • Eye movements
  • Physical timing
  • Smell
  • Cognitive abilities (e.g. memory, focus, attention)
  • Brainwaves
  • Vital signs (e.g. heart rate, blood pressure, breathing)
  • Blood sugar, hormone regulation, and other metabolic functions

Once functional deficits are identified; a host of neurological, cognitive, and metabolic rehabilitative interventions and processes can be employeding to normalize these functions as best possible – and, in many cases, entirely! Examples of such would include eye movement therapies, gait training, neurofeedback, physiotherapeutic modalities such as electrical stimulation and vibration, nutritional therapies, aromatherapy, visual and auditory training, meditation, lifestyle changes, and more.

While the quest continues to identify the best, evidence-based practices to combat this growing epidemic little to no therapeutic intervention; there are a small number of progressive centers that provide effective functional clinical interventions, as opposed to “wait and see”. Given the apparent lack of immediate shifts in the cultural circumstances that are causing brain injuries, and the inability or lack of desire of many to abstain from behaviors that are causing them, it is imperative that intervention with any head injury be focused largely on the therapeutic aspects once adequate healing time has passed.

One parting thought: There remains a sentiment in opposition to studies of the nature of the one referenced in FRONTLINE; dismissing the evidence as an overreaction too, and sensationalizing, highly specific group of individuals (football players get head injuries). My question to you is: If just one person in your family, community, etc. contracts a disease like polio:

If you knew there was something you could do, then why “wait and see”?

28 Comments

  1. Regina Bator on July 7, 2016 at 7:45 pm

    I had a head injury in2nd Grade I didn’t wake up the next day I was brought to the hospital was in there for 2 weeks, don’t remember much after that but all my youth into High school I was a cheerleader I am now 54 and 4 years ago I fell backwards into my tub hit the back of my head. I have been suffering from dizziness headaches, understanding what I hear, sensitive to smells confusion and so much more, my dr is treating me for blind seizures I don’t think its the case, please advise.

    • Dr. Michael Trayford on July 12, 2016 at 1:59 pm

      Regina:

      Although we cannot advise or draw any conclusions based on the limited information provided, we can consult with you via phone to gain more information and discuss options for you moving forward.

      Please call us at 828.708.5274 for a free 10-15 minute consultation and we can get into a bit more detail. There is likely more going in then just ‘blind seizures’, and a thorough functional neurological evaluation is warranted.

  2. Regina Bator on July 7, 2016 at 7:45 pm

    I had a head injury in2nd Grade I didn’t wake up the next day I was brought to the hospital was in there for 2 weeks, don’t remember much after that but all my youth into High school I was a cheerleader I am now 54 and 4 years ago I fell backwards into my tub hit the back of my head. I have been suffering from dizziness headaches, understanding what I hear, sensitive to smells confusion and so much more, my dr is treating me for blind seizures I don’t think its the case, please advise.

    • Dr. Michael Trayford on July 12, 2016 at 1:59 pm

      Regina:

      Although we cannot advise or draw any conclusions based on the limited information provided, we can consult with you via phone to gain more information and discuss options for you moving forward.

      Please call us at 828.708.5274 for a free 10-15 minute consultation and we can get into a bit more detail. There is likely more going in then just ‘blind seizures’, and a thorough functional neurological evaluation is warranted.

  3. kenny on July 4, 2016 at 9:48 am

    I had a car accident where I rolled my chev. Blazer 5 times, I was knocked out, had a concussion & did spent time with rehab. I had 2 more concussions when I was 6 yrs. Old. After my car accident & rehab.
    Will I have lifetime affects like headaches or other problems?

    • Dr. Michael Trayford on July 4, 2016 at 3:44 pm

      Greetings Kenny:

      Many do suffer from long-term ramifications of concussion or post-concussion syndrome with symptoms like headache, dizziness, memory loss, etc if not treated appropriately. I am unsure of what types of treatment you had and what the outcomes were.

      That said, please call us at 828.708.5274 to for a free brief consultation to discuss some potential options for you as there is hope for avoiding or minimizing these concerns.

      In the meantime, please look at this article I wrote on the long-term effects of untreated concussions – https://apexbraincenters.com/5-dangers-concussions/

      Take care.

  4. kenny on July 4, 2016 at 9:48 am

    I had a car accident where I rolled my chev. Blazer 5 times, I was knocked out, had a concussion & did spent time with rehab. I had 2 more concussions when I was 6 yrs. Old. After my car accident & rehab.
    Will I have lifetime affects like headaches or other problems?

    • Dr. Michael Trayford on July 4, 2016 at 3:44 pm

      Greetings Kenny:

      Many do suffer from long-term ramifications of concussion or post-concussion syndrome with symptoms like headache, dizziness, memory loss, etc if not treated appropriately. I am unsure of what types of treatment you had and what the outcomes were.

      That said, please call us at 828.708.5274 for a free brief consultation to discuss some potential options for you as there is hope for avoiding or minimizing these concerns.

      In the meantime, please look at this article I wrote on the long-term effects of untreated concussions – https://apexbraincenters.com/5-dangers-concussions/

      Take care.

  5. Rebecca Kavanaugh on June 29, 2016 at 9:35 am

    Dr. Trayford, I wish we lived in your area. I need similar resources in the area of San Antonio-Austin, TX. Can you recommend a physician or a clinic? Not happy at all with present neurologist. I would appreciate your help very much, and thank you.

    • Dr. Michael Trayford on June 29, 2016 at 5:10 pm

      Rebecca:

      Not certain of anyone in your immediate area. The nature of our programs is such that we see folks for short periods of time for intensive programming; meaning we work at a very high frequency over very short periods of time. With that, most of our admissions are coming from out of state as they are here for only 1-3 weeks; depending on the severity of their condition. With most conventional rehabilitation programs, you’d likely have to travel fair distances for much longer periods of time; which will cost more in time and finances in the long run.

      That said, if travel is not an option, we are also offering distance consulting services at this time.

      Please call our office as able for a free brief consultation to determine what the best option is for your at this particular time.

      We hope to talk with you soon.

  6. Rebecca Kavanaugh on June 29, 2016 at 9:35 am

    Dr. Trayford, I wish we lived in your area. I need similar resources in the area of San Antonio-Austin, TX. Can you recommend a physician or a clinic? Not happy at all with present neurologist. I would appreciate your help very much, and thank you.

    • Dr. Michael Trayford on June 29, 2016 at 5:10 pm

      Rebecca:

      Not certain of anyone in your immediate area. The nature of our programs is such that we see folks for short periods of time for intensive programming; meaning we work at a very high frequency over very short periods of time. With that, most of our admissions are coming from out of state as they are here for only 1-3 weeks; depending on the severity of their condition. With most conventional rehabilitation programs, you’d likely have to travel fair distances for much longer periods of time; which will cost more in time and finances in the long run.

      That said, if travel is not an option, we are also offering distance consulting services at this time.

      Please call our office as able for a free brief consultation to determine what the best option is for your at this particular time.

      We hope to talk with you soon.

  7. Glenna on February 5, 2016 at 4:11 pm

    What are some tests or measures for athletes who have suffered 5+ concussions in high school to ensure there aren’t any lasting effects. The patient is voicing concerns of “stuttering over words”, memory loss (short-term), “foggy feelings”, etc. There are noted mood swings, depression like symptoms, aggression, and irritability.

    • Dr. Michael Trayford on February 5, 2016 at 4:27 pm

      Glenna:

      At the very least they should have cognitive assessments covering areas of executive function, cognitive flexibility, reaction time, composite memory and complex attention, among others. Also, physical biomarkers of eye movements with videonystagmography and balance with dynamic posturography should be assessed. Sounds like they really need to get looked at. We’re available for consult at 828.708.5274 if they need.

  8. Glenna on February 5, 2016 at 4:11 pm

    What are some tests or measures for athletes who have suffered 5+ concussions in high school to ensure there aren’t any lasting effects. The patient is voicing concerns of “stuttering over words”, memory loss (short-term), “foggy feelings”, etc. There are noted mood swings, depression like symptoms, aggression, and irritability.

    • Dr. Michael Trayford on February 5, 2016 at 4:27 pm

      Glenna:

      At the very least they should have cognitive assessments covering areas of executive function, cognitive flexibility, reaction time, composite memory and complex attention, among others. Also, physical biomarkers of eye movements with videonystagmography and balance with dynamic posturography should be assessed. Sounds like they really need to get looked at. We’re available for consult at 828.708.5274 if they need.

  9. George Visger on October 19, 2015 at 1:33 pm

    96%?

    If it were 100% the $11 BILLION NFL would find a way to place blame on the player’s shoulders. Goodell will fight tooth and nail to protect his $44,000,000 (That’s $856,000/wk or $21,000/hr) salary.

    When will we put the value of a human life over that of entertainment?

    It’s only a game.

    George Visger
    SF 49ers 80 & 81
    Survivor of 9 NFL Caused Emergency VP Shunt Brain Surgeries
    Benefactor of ZERO NFL Benefits

    Wildlife Biologist/Traumatic Brain Injury Consultant
    The Visger Group – TBI Consulting
    http://www.thevisgergroup.org

    ESPN Outside The Lines http://espn.go.com/espn/story/_/page/George-Visger/george-visger-damage-done

    VICE Sports 091615 http://www.footballvets.org/blog/2015/09/aaron-gordon-battle-for-benefits-part-2/

    • Dr. Michael Trayford on October 28, 2015 at 10:37 am

      Well said, George!

    • Roy on November 26, 2015 at 2:04 am

      Is there any types of supplements that can slow down the progressiveness of CTE?

      • Dr. Michael Trayford on November 30, 2015 at 2:54 pm

        Thank you for your question, Roy. While this is still quite a new area of study and no longitudinal data exists just yet; it would make good sense that any neuro-protective supplements would be beneficial for lightening the effects of CTE. Examples would be antioxidants such as glutathione, N-acetylcysteine, flavinoids, Vitmain C and more. Brain healthy fats such as essential fatty acids and coconut oil. Anything that would help improve blood sugar handling. And, anti-inflammatory agents such as turmeric and others would likely be quite beneficial over the long haul. AS always, seek the advice of an expert prior to blindly adding anything to your diet, and remember, a good diet and lifestyle is your best protection overall.

  10. George Visger on October 19, 2015 at 1:33 pm

    96%?

    If it were 100% the $11 BILLION NFL would find a way to place blame on the player’s shoulders. Goodell will fight tooth and nail to protect his $44,000,000 (That’s $856,000/wk or $21,000/hr) salary.

    When will we put the value of a human life over that of entertainment?

    It’s only a game.

    George Visger
    SF 49ers 80 & 81
    Survivor of 9 NFL Caused Emergency VP Shunt Brain Surgeries
    Benefactor of ZERO NFL Benefits

    Wildlife Biologist/Traumatic Brain Injury Consultant
    The Visger Group – TBI Consulting
    http://www.thevisgergroup.org

    ESPN Outside The Lines http://espn.go.com/espn/story/_/page/George-Visger/george-visger-damage-done

    VICE Sports 091615 http://www.footballvets.org/

    • Dr. Michael Trayford on October 28, 2015 at 10:37 am

      Well said, George!

    • Roy on November 26, 2015 at 2:04 am

      Is there any types of supplements that can slow down the progressiveness of CTE?

      • Dr. Michael Trayford on November 30, 2015 at 2:54 pm

        Thank you for your question, Roy. While this is still quite a new area of study and no longitudinal data exists just yet; it would make good sense that any neuro-protective supplements would be beneficial for lightening the effects of CTE. Examples would be antioxidants such as glutathione, N-acetylcysteine, flavinoids, Vitmain C and more. Brain healthy fats such as essential fatty acids and coconut oil. Anything that would help improve blood sugar handling. And, anti-inflammatory agents such as turmeric and others would likely be quite beneficial over the long haul. AS always, seek the advice of an expert prior to blindly adding anything to your diet, and remember, a good diet and lifestyle is your best protection overall.

  11. Terry Hollifield on October 2, 2015 at 9:10 am

    Great stuff here, Dr. Trayford. I’m continually amazed at the way these facts are scuttled away by wilful ignorance so that we can still enjoy “America’s game”. I love football as much as the next guy, but at some point we have to have the adult conversation about the reality of the impacts of brain injuries in its participants and those who participate in other contact sports. Thanks again.

    • Dr. Michael Trayford on October 2, 2015 at 10:02 am

      Thank you, Terry. Well said!

  12. Terry Hollifield on October 2, 2015 at 9:10 am

    Great stuff here, Dr. Trayford. I’m continually amazed at the way these facts are scuttled away by wilful ignorance so that we can still enjoy “America’s game”. I love football as much as the next guy, but at some point we have to have the adult conversation about the reality of the impacts of brain injuries in its participants and those who participate in other contact sports. Thanks again.

    • Dr. Michael Trayford on October 2, 2015 at 10:02 am

      Thank you, Terry. Well said!

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